“…neighborhood environmental factors—from local economic opportunities, to social interactions with neighbors, to the physical environment, to services such as local grocery stores where people can buy nutritious food—all affect individual health.” Why Place Matters, 2007, Policy Link and The California Endowment
In the almost 10 years since Why Place Matters was released, it’s been clearly established that where you live is one of the most critical factors in your physical, psychological and emotional health. Nowhere is this more evident in the United States than in low-income neighborhoods, which are too often subject to poor air quality, soil pollution, lead contamination, and other detrimental environmental factors, as well as a lack of services and adequate healthy food outlets.
In Rhode Island, the state health department developed their health equity zone program in an effort to mitigate the disparities and inequities present in living in some neighborhoods in the Ocean State. The Newport Health Equity Zone (HEZ) is a particularly unique example of a new approach to public health prevention and intervention, according to Olivia Kachingwe, who coordinates the effort for the Newport Women’s Resource Center (WRC).
Unusual Funder Funded
“We are quite an unusual agency to be funded for this type of grant,” she says, because the WRC is not a hospital or other clinical provider. They are a domestic violence non-profit, which prior to the Health Equity Program, had never received funding from the R.I. Department of Health. The WRC had, however, received past funds from the Centers for Disease Control that encouraged them to look at community level factors that influence rates of domestic violence.
“So we have been doing a lot of community-level work in Newport prior to receiving the HEZ grant. We continue to focus on social cohesion as a determinant for domestic violence, and that made us feel comfortable and prepared to apply for this funding to improve health outcomes. “We understood health equity, we understood neighborhood- and community-level work and we understood the various community level-drivers of health disparities,” says Kachingwe.
Knowing the Neighborhoods
Kachingwe and WRC Director of Prevention Jessica Walsh, who wrote the HEZ grant, also know the two areas of town the Newport HEZ comprises: the “North End” and “Off Broadway.” “We knew for sure that we wanted to work with the North End because that area has the highest low-income population,” Kachingwe says. “There are a lot of low-income housing developments and preliminary data highlighted some pre-existing health disparities.
“We also included the Broadway neighborhood; it’s much different because you have a thoroughfare of small businesses right on Broadway and then, on either side of Broadway, you have apartments and homes and it’s a mix of income levels. The mix of income levels is also true in the North End but I would say what separates the two neighborhoods are their zoning laws. The commercial area in the North End is a lot more concentrated.”
Kachingwe and Walsh knew even in preparing the grant application that coalition building, with both local organizations and residents, would be the first task, since the key to success would be community engagement. So they began recruiting local partners.
Building Constituent Working Groups
“We came up with working groups in six different areas that influence health outcomes and we picked a local partner to lead each working group because of their pre-existing knowledge in the content area,” Kachingwe explains. “For example, the transportation working group is led by Bike Newport and the open space group is led by the Aquidneck Land Trust.”
The other working groups in the collaborative are:
- The Food Access working group, led by the Martin Luther King Jr. Community Center;
- The Education, Innovation and Economic Opportunity working group, led by Fab Newport;
- The Arts and Culture working group, led by the Arts and Culture Alliance of Newport County;
- and The Physical and Emotional Health working group, led by the Boys and Girls Clubs of Newport County.
The working groups range in size from six to ten people; each group includes at least two residents; the collaborative as a whole has upwards of 60 members.
“Another thing that is worth noting about our process is that we have residents that sit on each of the working groups and are decision-makers in the process and that really drives what we do,” Kachingwe says, “and this is a key component of what the Newport HEZ is and one of our principles. These residents were also helping to inform what the needs assessment ultimately looked like.” She adds that the residents are paid “because we follow an equity framework as well. Their time and involvement is not ‘tokenized’.”
The six groups chosen to lead the working groups were handpicked due to their size (most are small), their previous relationship and partnerships with the WRC, and the on-the-ground nature of their work, Kachingwe notes. “This helped us ensure collaborative members that work well with each other and a collaborative that is truly ready to engage in health-equity work, which requires a shared power dynamic among partners and the community members.
“In year one, we needed to do a needs assessment and because in many ways we were charting new waters, we didn’t have a lot of data in house letting us know what key disparities were present, and what factors were causing the disparities” Kachingwe says, adding that “we let the working groups decide the questions they wanted to ask, how they wanted to ask them, and of whom they wanted to ask them.
2015-16: Year One
So, in year one, the working groups used various methods of data collection to ask key questions. “We did 16 focus groups across the lifespan—one with kids, one with high school students, one with men only, one with parents, one with seniors— and we did a survey and we had over 500 responses, 250 of which were from people that lived in health equity zone,” Kachingwe recounts.
The education working group collected 20 storytelling narratives, she adds, “because they didn’t want to design a survey or a focus group protocol that dictates what’s valued in terms of education or economic success, but wanted something much more open that allowed community members to share their own narratives and make their own judgment calls and define their own life quality.”
From there,” Kachingwe says, the collaborative “designed something called the Creativity Lab that was our way of sharing back with the community all the information that we heard and asking: Did we hear it right? Is there anything that you want to add? It also gave the community a space to start prioritizing needs and developing solutions. It was in a gym and we transformed the space to visually represent our data. We gave everyone as they walked in a bag with stickers and markers so they could literally write on the walls and react to with our findings. This was a great way to get feedback.
After the Creativity Lab, the collaborative members met again to look at the data gathered and the feedback from the lab. At that point, the HEZ designated “priority areas that we wanted to focus on in year two,” Kachingwe says, noting that year two started in March.
Year Two Priorities
“In year two we have three working groups,” Kachingwe says. “One is the transportation working group, and their goal for this year is to come up with a plan that increases the walkability and bikeability of Newport. The second working group is food access, and they’re doing two things. One is working with local farmers’ markets to increase SNAP and WIC redemption at the markets.”
The food access group is also working to help the community adopt Shop Healthy NYC, a model for increasing healthy foods in neighborhood stores. “We’re implementing something that New York did. Luckily for us, they have a whole implementation guide that’s available to the public that we’re following,” Kachingwe says. “It’s all about working with small corner stores and bodegas and using marketing strategies such as product placement to increase sales of healthy foods.”
The third group with funding this year, Kachingwe says, is the physical and emotional health working group that’s led by the Boys and Girls Club. “Their primary task is to oversee the wellness hubs we opened this year, one at the Martin Luther King Ctr. and the other at the Florence Gray Center.
Giving the HEZ a Face
“These wellness hubs are our outward face to the community,” Kachingwe explains. As a collaborative comprising different agencies, “if you’re looking for a bricks-and-mortar location that’s associated with the Health Equity Zone, you wouldn’t really find that. So the wellness hubs give us a physical location and interface with the community that wears its own hat.”
The wellness hubs are also offering year-long, diabetes prevention programs for at risk residents, she says, based on a CDC evidence-based curriculum. The classes meet once a week for the first six months and then every six to eight weeks after that.
“At the beginning of every class they weigh the participants; the goal is that the participants will lose weight for the year. So it’s about getting them out of that red area of being at risk,” Kachingwe says. “It’s about portion control, about tracking fat content and about in general knowing what you’re eating and consuming foods smartly.
“It’s also meant to be a support group in which members help each other to meet their own goals,” she adds, noting, “It’s a lifestyle change program, not a diet.”
An Empowering RFP Process
The HEZ collaborative also created this year an Request-for-proposal (RFP) process that “empowers residents to apply for small seed money to do projects out of these wellness hubs that improve the overall well-being of residents and community members,” Kachingwe says. She admits the RFP has been “a massive undertaking to figure out structurally and programmatically, but we wanted to empower residents to take ownership of not only their own outcomes but the whole community’s outcomes.
“So every couple months we put out an RFP that is geared for residents to apply and receive seed money. Right now, we have a Butler basketball program going on and a senior walking group class that goes on weekly and a parent-child yoga class; a couple months ago we did an African-American walking history tour of Newport. So by empowering residents, we’re getting a lot of innovative programs that we’re able to fund.” Kachingwe notes it is the job of the physical and emotional health working group to develop and put out the RFP, advertise the RFP, and come up with criteria for deciding proposals we want to fund. “They also buy the needed equipment and a lot of that nitty-gritty that goes into a program implementation,” she adds.
“Though funding restrictions led us to have three working groups this year instead of six,” Kachingwe says, “the education group, the open-space group and the arts and culture group are still part of our collaborative and inform our decision making. Even though we’ve broken things up into three categories we understand that they’re very fluid.
“Just as an example, if you’re working with farmers markets, even though that’s a food-access initiative, if we’re talking about where is food sold and can we sell it or grow it someplace different, open space also becomes part of that conversation. So there’s also a ton of ways in which this is very fluid and we need all six groups to be a part of our process and be apart of the conversation.”